August 1st, Scaphoid Fractures. Dr. Christine Walton, PGY 2 Orthopedics

Size: px
Start display at page:

Download "August 1st, 2006. Scaphoid Fractures. Dr. Christine Walton, PGY 2 Orthopedics"

Transcription

1 August 1st, 2006 Scaphoid Fractures Dr. Christine Walton, PGY 2 Orthopedics

2 Injury Patterns to the Carpal Bones 1) Perilunate pattern injuries 2) Axial pattern injuries 3) Local impaction/avulsion injuries

3 Perilunate Pattern Injuries injuries which occur in an arc around the lunate Includes # of the scaphoid, most capitate # and some triquetral #s Any # in the above bones should prompt a search for other injuries (joints/bones) along the perilunate injury pathway Classification = Unstable surgical intervention force = ligamentous injury Scapholunate joint Stage I = scapholunate dissociation Lunate Triquetrum Stage IV = lunate / perilunate dislocation radial deviation = arc around the lunate Mayfield et al.

4 Axial Pattern Injuries The result of powerful anteroposterior compression forces (explosion injury or severe crush) Injury pattern propagates in both the radial and ulnar direction separates the carpus on either side of the capitate Unstable requires surgical treatment

5 Local Impaction / Avulsion Injuries Isolated carpal bone injuries that occur due to localized force concentration Includes: Dorsal chip fractures of the triquetrum Trapezial ridge fractures Pisiform fractures Hamate hook fractures Avascular necrosis of carpal bones Kienbock s disease Preiser s desease AVN of the pisiform and capitate

6 Scaphoid Fractures Most commonly fractured carpal bone (80% incidence) 2 nd most common upper extremity fracture (1 st Distal radius) M/I : FOOSH, wrist extended Males > Females Ages Scaphoid fracture distribution Rare in children (distal 1/3) proximal 1/3. waist..65% 25% distal 1/3 10% Often mislabelled as just a sprain high index of suspicion needed

7 17% of patients with scaphoid #s have associated injuries: Transscaphoid perilunar dislocations Trapezium fractures Bennett fractures Radial head fractures Lunate dislocations Fractures of the distal radius

8 Anatomy of the Scaphoid 5 articulating surfaces (radius, lunate, capitate, trapezium, trapezoid) Shape: center of the distal articular surface is palmar to the proximal articular surface, resulting in the production of a flexion moment of the scaphoid with axial loading of the wrist Multiple ligamentous attachments almost entirely covered by cartilage

9 Blood Supply to the Scaphoid Extraosseous vessels enter the middle and distal portions of the scaphoid Proximal pole receives no direct vascular supply - intraosseous vessels pass retrograde from the waist

10 Obletz and Halbstein 67% of scaphoid bones have arterial foramina throughout their length, including the distal, middle, and proximal thirds 13% have blood supply predominantly in the distal third 20% have most of the arterial foramina in the waist area of the bone with no more than a single foramen near the proximal third 1/3 of scaphoid fractures occurring in the proximal third may be without adequate blood supply, and this seems to be borne out clinically prevalence of AVN can be as high as 35% in fractures at this level

11 Scaphoid arterial blood supply. The dorsalscaphoid branch (1) enters at the waist and supplies the proximal 70% 80% of the bone. The volar scaphoid branch of the radial artery (2) supplies the distal 20% 30%. Rettig AC. Managementof acute scaphoid fractures. Hand Clin 2000;16(3):382

12 Mechanism of injury failure of bone caused by a compressive or tension load Wrist extension < 35 = Fracture of the forearm > 90 = # of the carpal bones Wrist Extension Proximal pole locks in the scaphoid fossa of the radius Distal pole moves excessively dorsal Fractures of the scaphoid were consistently produced in fresh cadaver specimens when radial deviation was added to an extended wrist ( ), and force applied to the radial half of the palm Green s operative hand surgery, 2005

13 Distal fractures extension of the wrist Proximal fractures result from initial dorsal subluxation of the scaphoid before forced supination Waist fractures results when the palmar ligaments (radioscaphocapitate) act as a fulcrum on which the distal pole may flex palmarly

14 Investigations History (FOOSH) Physical Examination: Tenderness with Palpn over the scaphoid tubercle snuff-box with longitudinal compression Diagnostic sensitivity 100%

15

16 Routine X-rays of the Scaphoid Posteroanterior - fingers flexed into a fist position to produce slight extension and ulnar deviation - places the longitudinal axis of the scaphoid in a plane more closely parallel with that of the film - accentuates a scapholunate gap (r/o injury) Lateral - helpful for evaluation of carpal alignment and determination of carpal instability Oblique (x2) *wrist slightly extended in ulnar deviation is helpful*

17 Routine X-ray Series for Scaphoid bone A-P Lateral Oblique pronation 45 Oblique supination 45

18 Navicular Fat Stripe (Scaphoid fat pad sign) A small radiolucent area normally present next to the scaphoid in A-P Radiographs A linear collection of fat b/w the radiocollateral ligament and the tendon sheaths of the Abductor pollicis longus and extensor pollicis brevis A fracture on the radial side of the wrist can either displace or obliterate this line Found to be a poor predictor of scaphoid fracture (Terry and Ramin)

19 $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$ What management would you propose if there was no fracture identified on the x-ray?? $$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$$

20 Primary Care,Volume 32, 2005

21 Bone scan sensitivity 100% specificity of 98% positive predictive value of 93% False -ve: traumatic synovitis S-L tear 2 weeks after the injury, a ve bone scan excludes a fracture. If +ve, CT scan or immobilize and repeat x-rays in 3 weeks Cost-effectiveness of diagnostic strategies for suspected #s: initial radiographs, with bone scan at 2 weeks. Teil-van Buul et al a bipartite scaphoid is considered so rare as to be of little or no clinical significance

22 J Bone Joint Surg Br 1984;66: The Herbert Classification of Scaphoid Fractures Type A: stable acute fractures A1. Fracture of tubercle A2. Incomplete fracture of the waist (middle third) Type B: unstable acute fractures B1. Distal oblique B2. Complete or displaced waist fracture B3. Proximal pole fracture B4. Trans-scaphoid perilunate dislocation fracture B5. Comminuted fracture Type C: delayed union Type D: established union D1. Fibrous nonunion (stable) D2. Displaced nonunion (unstable)

23

24 Nondisplaced, Stable Scaphoid Fractures Acute Nondisplaced Stable fractures No bony / ligamentous injury In children Conservative Treatment * better prognosis with early diagnosis *

25 Treatment of Nondisplaced Stable # Cast Immobilization Expected rate of union, 90-95% in weeks Removable short arm thumb spica cast vs. Long arm thumb spica cast Delayed Dx or # in Proximal 1/3 = 6/52 Terkelsen and Jepsen N=92, P>0.05 (rate of nonunion) Gellman et al 6/12 LSC = 3/12 faster Serial X-rays Repeat x-rays q 1-3/52 to assess bone healing Collapse or angulation of the fractured fragments = Sx special nonoperative or operative treatment considerations for patient population

26 Displaced, Unstable Scaphoid Fractures Unstable Fracture: Fragments are offset > 1 mm in the A-P or oblique view OR if lunocapitate angulation is greater than 15 degrees OR scapholunate angulation > 45 in lateral view (N = ) Other Criteria a lateral intrascaphoid angle greater than 45 an A-P intrascaphoid angle less than 35 a height-to-length ratio of 0.65 or more

27

28 Nonunion of Scaphoid Fractures Common causes: delayed Dx (~ 40%), gross displacement, assoc. injuries and impaired blood supply Delayed treatment (> 4wks) can result in a nonunion rates of 88%. The incidence of avascular necrosis is approximately 30% to 40% (usually involves the proximal third) The following operations can be used for nonunions: (1) radial styloidectomy (2) excision of the proximal fragment the distal fragment, and, occasionally, the entire scaphoid (3) proximal row carpectomy (4) traditional bone grafting (5) vascularized bone grafting (6) partial or total arthrodesis of the wrist.

29 Scaphoid Nonunion Advanced Collapse (SNAC) pattern.watson and Ballet Describes X-ray findings of arthritis usually seen with scaphoid nonunion: radioscaphoid narrowing capitolunate narrowing cyst formation pronounced dorsal intercalated segment instability (DISI) Radiolunate joint is usually spared as well as the proximal pole + corr. Radial surface Scapholunate Advanced Collapse (SLAC) Progressive arthritis due to SL interval disruption with Flx deformity of the scaphoid and DISI of the proximal carpal row Stage I: arthritis b/w the scaphoid and radial styloid Stage II: arthritis b/w the scaphoid and the entire scaphoid facet of the radius Stage III: Above, + arthritis b/w the capitate and lunate

30 Dorsal intercalated segmental instability(disi). Sagittal T1-weighted image shows the dorsal tilt of the lunate (longarrow) and proximal migration of the capitate (short arrow).

31 Scapholunate advance collapse (SLAC): endstage of SL instability. The SL ligament is torn and there is widening of the interval. There is advanced radiocarpal arthritis, proximal migration of the capitate, and midcarpal arthritis.

32 The inlay (Russe) graft Bone Grafts for Nonunion - union rate of 92% - not used for adjacent carpal collapse or humpback deformity Interposition (Fisk) graft - opening-wedge graft designed to restore scaphoid length and angulation - used to correct adjacent carpal instability - union rates of 72% - 95% Vascularized bone graft - a distal radius vascularized bone pedicle graft, 1-2 intercompartmental supraretinacular artery (ICSRA) - only used for difficult cases (previously failed grafts) - harvested from the distal radius - increased success when AVN involved

33 Decision-making for Treatment Options Duration: Acute fractures are defined as being less than 3 weeks old Delayed union is defined as failure to heal by 4 to 6 months Ununited fractures older than 6 months are considered nonunions Location: * prognostic implications Orientation: the plane of the fracture. Horizontal oblique, vertical oblique, and transverse fractures; Vertically oriented fractures are less stable and, consequently, less likely to heal. Displacement: > 1 mm stepoff on any view, a scapholunate angle of >60, a lunocapitate angle >15, or a lateral intrascaphoid angle > 20 (Dramatic affect on conservatively treated waist fractures) Comminution: Comminuted fractures are inherently unstable. Associated injuries: Scaphoid #s commonly accompany perilunate dislocations

34 Canale: Campbell's Operative Orthopaedics, 10th ed., Copyright 2003 Mosby, Inc. Surgical Approach to the Scaphoid The Volar approach best exposure for scaphoid fractures at and distal to the waist The Dorsal approach For noncomminuted fractures in the proximal pole of the scaphoid Intra-op The most reliable sign of vascular proximal pole is punctuate bleeding if obvious = union rate of 92% if questionable = union rate of 71% if no bleeding = union rate of 0%

35 Summary of Treatment Options Fresh stable undisplaced - Short arm / long arm TS cast - Percutaneous compression screw Fresh undisplaced Potentially unstable (vertical oblique or reduced Trans-scaphoid dislocations) Previously untx stable #s (older than 3 weeks) - Percutaneous compression screw fixation - long-arm/thumb spica cast Fresh displaced / angulated - ORIF (Kirschner wires or Herbert screw) Nonunions, asymptomatic stable (Strong likelihood of late OA) - Russ-type graft - Vascularized graft

36 Continued... Symptomatic nonunions without OA, AVN or Carpal collapse Vascularized graft with addition of Compression screw or russe-type graft Nonunions with carpal collapse (DISI) without OA or AVN Nonunions with limited OA without AVN Nonunions with definitive AVN Nonunions + extensive OA Anterior wedge bone graft with internal fixation (K-wires / herbert screw) or vascularized graft Bone Graft and limited styloidectomy or scaphoid excision + midcarpal fusion Vascularized bone graft or replacement of the Proximal fragment with soft tissue or scaphoid excision and midcarpal arthrodesis Excision of the scaphoid with midcarpal arthrodisis or total wrist arthrodesis

37 Post-op Treatment Immobilization in an elbow-to-thumb spica cast (6-8 wks) + / - Kirschner wires are removed at 6 to 8 weeks Screw fixation can be left in place permanently unless tender At 6 to 8 weeks, a short arm thumb spica cast is applied After cast removal wrist motion and elbow motion are increased gradually, followed by strengthening exercises.

38 The END

Scaphoid Fractures 1

Scaphoid Fractures 1 1 Scaphoid Fractures Scaphoid Fractures Introduction Anatomy Biomechanics History Clinical examination Radiographic evaluation DDx Classification Treatment Complications 2 Scaphoid fractures Introduction

More information

Wrist Fractures. Wrist Defined: Carpal Bones Distal Radius Distal Ulna

Wrist Fractures. Wrist Defined: Carpal Bones Distal Radius Distal Ulna Wrist Fractures Wrist Fractures Wrist Defined: Carpal Bones Distal Radius Distal Ulna Wrist Fractures Wrist Joints: CMC Intercarpal Radiocarpal DRUJ drudge Wrist Fractures Wrist Fractures: (that we are

More information

RADIOGRAPHIC EVALUATION

RADIOGRAPHIC EVALUATION Jeff Husband MD Objectives Evaluate, diagnose and manage common wrist injuries due to high energy trauma in athletes Appropriately use radiographs, CT scans and MRI Know when to refer patients for additional

More information

DIAGNOSING SCAPHOID FRACTURES. Anthony Hewitt

DIAGNOSING SCAPHOID FRACTURES. Anthony Hewitt DIAGNOSING SCAPHOID FRACTURES Anthony Hewitt Introduction Anatomy of the scaphoid Resembles a deformed peanut Articular cartilage covers 80% of the surface It rests in a plane 45 degrees to the longitudinal

More information

Fractures around wrist

Fractures around wrist Fractures around wrist Colles Fracture Smiths fracture Barton s fracture Chauffer s fracture Scaphoid fracture Lunate dislocation Vivek Pandey Colles fracture Definition: Fracture of the distal end radius

More information

INJURIES OF THE HAND AND WRIST By Derya Dincer, M.D.

INJURIES OF THE HAND AND WRIST By Derya Dincer, M.D. 05/05/2007 INJURIES OF THE HAND AND WRIST By Derya Dincer, M.D. Hand injuries, especially the fractures of metacarpals and phalanges, are the most common fractures in the skeletal system. Hand injuries

More information

Common wrist injuries in sport. Chris Milne Sports Physician Hamilton,NZ

Common wrist injuries in sport. Chris Milne Sports Physician Hamilton,NZ Common wrist injuries in sport Chris Milne Sports Physician Hamilton,NZ Overview / Classification Acute injuries Simple - wrist sprain Not so simple 1 - Fracture of distal radius/ulna 2 - Scaphoid fracture

More information

Scaphoid Non-union. Dr. Mandel Dr. Gyomorey. May 3 rd 2006

Scaphoid Non-union. Dr. Mandel Dr. Gyomorey. May 3 rd 2006 Scaphoid Non-union Dr. Mandel Dr. Gyomorey May 3 rd 2006 Introduction Scaphoid fracture incidence: 8-38/100,000 Non-union 5% (0-22%) Adams and Leonard (1928) first described operative treatment of the

More information

Scaphoid Fractures- Anatomy And Diagnosis: A Systemic Review Of Literature

Scaphoid Fractures- Anatomy And Diagnosis: A Systemic Review Of Literature Article ID: WMC001268 ISSN 2046-1690 Scaphoid Fractures- Anatomy And Diagnosis: A Systemic Review Of Literature Corresponding Author: Dr. Dharm Meena, junior resident, orthopaedics, PGIMER, E 402, MDH,PGIMER,CHANDIGARH,

More information

NERVE COMPRESSION DISORDERS

NERVE COMPRESSION DISORDERS Common Disorders of the Hand and Wrist Ryan Klinefelter, MD Associate Professor of Orthopaedics Department of Orthopaedics The Ohio State University Medical Center NERVE COMPRESSION DISORDERS 1 Carpal

More information

Most active and intricate part of the upper extremity Especially vulnerable to injury Do not respond well to serious trauma. Magee, 2008. pg.

Most active and intricate part of the upper extremity Especially vulnerable to injury Do not respond well to serious trauma. Magee, 2008. pg. PTA 216 Most active and intricate part of the upper extremity Especially vulnerable to injury Do not respond well to serious trauma Magee, 2008. pg. 396 28 bones Numerous articulations 19 intrinsic muscles

More information

WRIST EXAMINATION. Look. Feel. Move. Special Tests

WRIST EXAMINATION. Look. Feel. Move. Special Tests WRIST EXAMINATION Look o Dorsum, side, palmar- palmar flex wrist to exacerbate dorsal swellings o Deformity e.g. radial deviation after colles, prominent ulna o Swellings e.g. ganglion o Scars, muscle

More information

Distal Radius Fractures. Lee W Hash, MD Affinity Orthopedics and Sports Medicine

Distal Radius Fractures. Lee W Hash, MD Affinity Orthopedics and Sports Medicine Distal Radius Fractures Lee W Hash, MD Affinity Orthopedics and Sports Medicine The Problem of Distal Radius Fractures Common injury: >450,000/yr. in USA High potential for functional impairment and frequent

More information

Wrist and Hand Injuries Keep Your Edge: Hockey Sports Medicine 2015 Toronto, Canada August 28-30

Wrist and Hand Injuries Keep Your Edge: Hockey Sports Medicine 2015 Toronto, Canada August 28-30 Wrist and Hand Injuries Keep Your Edge: Hockey Sports Medicine 2015 Toronto, Canada August 28-30 Steven E. Rokito, MD Division Chief, Sports Medicine, NSLIJ Associate team orthopedist NY Islanders Wrist

More information

Musculoskeletal Trauma of the Wrist

Musculoskeletal Trauma of the Wrist September 2000 Musculoskeletal Trauma of the Wrist Murat Akalin, Harvard Medical School, Year- IV Gillian Lieberman, MD The Wrist Most common site of injury in entire skeleton Distal radius and ulna fractures

More information

The Emergent Evaluation and Treatment of Hand and Wrist Injuries

The Emergent Evaluation and Treatment of Hand and Wrist Injuries The Emergent Evaluation and Treatment of Hand and Wrist Injuries Michael K. Abraham, MD, MS a,b, *, Sara Scott, MD a,c KEYWORDS Hand and wrist injuries Emergency physician Emergent evaluation Treatment

More information

Wrist Fractures. Wrist Injuries/Pain. Upper Extremity Care in an Aging Population. Objectives. Jon J. Cherney, M.D. Fractures of the Distal Radius

Wrist Fractures. Wrist Injuries/Pain. Upper Extremity Care in an Aging Population. Objectives. Jon J. Cherney, M.D. Fractures of the Distal Radius Upper Extremity Care in an Aging Population Hand and Upper Extremity Center of Northeast Wisconsin, Ltd. Symposium February 24, 2012 1 2 Objectives Wrist Injuries/Pain by Jon J. Cherney, M.D. Anatomy History/Evaluation

More information

Wrist Ligaments and Instability

Wrist Ligaments and Instability Wrist Ligaments and Instability The Wrist The wrist or carpus provides a stable support for the hand, allowing for the transmission of grip forces as well as positioning of the hand and digits for fine

More information

Wrist Fractures: What the Clinician Wants to Know 1

Wrist Fractures: What the Clinician Wants to Know 1 What the Clinician Wants to Know Charles A. Goldfarb, MD Yuming Yin, MD Louis A. Gilula, MD Andrew J. Fisher, MD Martin I. Boyer, MD Index terms: Bones, CT, 43.1211 Wrist, fractures, 43.41 Wrist, MR, 43.12141,

More information

Comparison Of Ct And Plain Film For The Postoperative Assessment Of Scaphoid Fracture Healing

Comparison Of Ct And Plain Film For The Postoperative Assessment Of Scaphoid Fracture Healing Yale University EliScholar A Digital Platform for Scholarly Publishing at Yale Yale Medicine Thesis Digital Library School of Medicine January 2011 Comparison Of Ct And Plain Film For The Postoperative

More information

Ulnar sided Wrist Pain

Ulnar sided Wrist Pain Ulnar sided Wrist Pain 1 Susan Cross, 1 Anshul Rastogi, 2 Brian Cohen, 1 Rosy Jalan 1 Dept of Radiology, Barts Health NHS Trust, London, UK 2 London Orthopaedic Centre Contact: susan.cross@bartshealth.nhs.uk

More information

The intricate anatomy and compartmentalization of structures

The intricate anatomy and compartmentalization of structures Radiographic Evaluation of the Wrist: A Vanishing Art Rebecca A. Loredo, MD,* David G. Sorge, MD, Lt. Colonel, and Glenn Garcia, MD The intricate anatomy and compartmentalization of structures in the wrist

More information

Systemic condition affecting synovial tissue Hypertrohied synovium destroys. Synovectomy. Tenosynovectomy Tendon Surgery Arthroplasty Arthrodesis

Systemic condition affecting synovial tissue Hypertrohied synovium destroys. Synovectomy. Tenosynovectomy Tendon Surgery Arthroplasty Arthrodesis Surgical Options for Rheumatoid Arthritis of the Wrist Raj Bhatia Consultant Hand & Orthopaedic Surgeon Bristol Royal Infirmary & Avon Orthopaedic Centre Rheumatoid Arthritis Systemic condition affecting

More information

The Wrist I. Anatomy. III. Wrist Radiography Typical wrist series: Lateral Oblique

The Wrist I. Anatomy. III. Wrist Radiography Typical wrist series: Lateral Oblique monteleoneg@wvuh.com The Wrist I. Anatomy The wrist is a complex system of articulations comprising 27 articular surfaces among the radius, ulna, carpus, and metacarpals. It is generally agreed that the

More information

Radial Head Fracture Repair and Rehabilitation

Radial Head Fracture Repair and Rehabilitation 1 Radial Head Fracture Repair and Rehabilitation Surgical Indications and Considerations Anatomical Considerations: The elbow is a complex joint due to its intricate functional anatomy. The ulna, radius

More information

The 10 Most Common Hand Pathologies In Adults. 1. Carpal Tunnel and Cubital Tunnel

The 10 Most Common Hand Pathologies In Adults. 1. Carpal Tunnel and Cubital Tunnel The 10 Most Common Hand Pathologies In Adults Bobbi Jacobsen PA C 1. Carpal Tunnel and Cubital Tunnel CARPAL TUNNEL (median nerve) ( ) Pain and numbness Distal, proximal radiating Sensory disturbance Distribution

More information

3.1. Presenting signs and symptoms; may include some of the following;

3.1. Presenting signs and symptoms; may include some of the following; Title: Clinical Protocol for the management of Forearm and Wrist injuries. Document Owner: Deirdre Molloy Document Author: Deirdre Molloy Presented to: Care & Clinical Policies Date: August 2015 Ratified

More information

IFSSH Scientific Committee on. Wrist Biomechanics and Instability

IFSSH Scientific Committee on. Wrist Biomechanics and Instability IFSSH Scientific Committee on Wrist Biomechanics and Instability Chair: Hisao Moritomo (Japan) Committee: Emmanuel Apergis (Greece) Guillaume Herzberg (France) Scott Wolfe (USA) Jose Maria Rotella (Argentina)

More information

PERILUNATE AND LUNATE DISLOCATIONS

PERILUNATE AND LUNATE DISLOCATIONS PERILUNATE AND LUNATE DISLOCATIONS Rebecca Morris Advanced Practitioner Plain Film Reporting March 2011 Perilunate and Lunate dislocations Introduction Definition Anatomy Clinical presentation Mechanism

More information

Chpter 2 Nonoperative Management of Non-displaced Acute Scaphoid Fracture

Chpter 2 Nonoperative Management of Non-displaced Acute Scaphoid Fracture Chpter 2 Nonoperative Management of Non-displaced Acute Scaphoid Fracture Megan Tomaino and Thomas B. Hughes Case Presentation The patient is a 15-year-old male with a history of left wrist pain following

More information

Imaging of Lisfranc Injury

Imaging of Lisfranc Injury November 2011 Imaging of Lisfranc Injury Greg Cvetanovich, Harvard Medical School Year IV Agenda Case Presentation Introduction Anatomy Lisfranc Injury Classification Imaging Treatment 2 Case Presentation

More information

Wrist and Hand. Patient Information Guide to Bone Fracture, Bone Reconstruction and Bone Fusion: Fractures of the Wrist and Hand: Carpal bones

Wrist and Hand. Patient Information Guide to Bone Fracture, Bone Reconstruction and Bone Fusion: Fractures of the Wrist and Hand: Carpal bones Patient Information Guide to Bone Fracture, Bone Reconstruction and Bone Fusion: Wrist and Hand Fractures of the Wrist and Hand: Fractures of the wrist The wrist joint is made up of the two bones in your

More information

Hand and Upper Extremity Injuries in Outdoor Activities. John A. Schneider, M.D.

Hand and Upper Extremity Injuries in Outdoor Activities. John A. Schneider, M.D. Hand and Upper Extremity Injuries in Outdoor Activities John A. Schneider, M.D. Biographical Sketch Dr. Schneider is an orthopedic surgeon that specializes in the treatment of hand and upper extremity

More information

Hand and Wrist Injuries. Hmmm... 2/24/2015

Hand and Wrist Injuries. Hmmm... 2/24/2015 Hand and Wrist Injuries John J Shaff, PA-C Hand Surgery Specialists, P.C. Hmmm... The field of hand surgery deals with both surgical and non-surgical treatment of conditions and problems that may take

More information

Scaphoid Fracture of the Wrist

Scaphoid Fracture of the Wrist Page 1 of 6 Scaphoid Fracture of the Wrist Doctors commonly diagnose a sprained wrist after a patient falls on an outstretched hand. However, if pain and swelling don't go away, doctors become suspicious

More information

Chapter 7 The Wrist and Hand Joints

Chapter 7 The Wrist and Hand Joints Chapter 7 The Wrist and Hand Manual of Structural Kinesiology R.T. Floyd, EdD, ATC, CSCS Many Archery, Relate wrist require sports require precise functioning of flexion, & hand & hand functional combined

More information

Commonly Missed Fractures in the Emergency Department

Commonly Missed Fractures in the Emergency Department Commonly Missed Fractures in the Emergency Department Taylor Sittler MS IV - UMASS Images courtesy of Jim Wu, MD, Sanjay Shetty, MD and Mary Hochman, MD Diagnostic Errors in the ED Taylor Sittler, MS IV

More information

BODY BODY PEDICLE PEDICLE TRANSVERSE TRANSVERSE PROCESS PROCESS

BODY BODY PEDICLE PEDICLE TRANSVERSE TRANSVERSE PROCESS PROCESS Learning Objective Radiology Anatomy of the Spine and Upper Extremity Identify anatomic structures of the spine and upper extremities on standard radiographic and cross-sectional images Timothy J. Mosher,

More information

NOW PLAYING THE WRIST. David Costa, OTR/L October 20, 2007

NOW PLAYING THE WRIST. David Costa, OTR/L October 20, 2007 NOW PLAYING THE WRIST David Costa, OTR/L October 20, 2007 Starring Radius Ulna Scaphoid Lunate Triquetrum Trapezium Trapezoid Capitate Hamate Pisiform TFCC Transverse Carpal Ligament Scapholunate Ligament

More information

Acute Scapholunate and Lunotriquetral Dissociation

Acute Scapholunate and Lunotriquetral Dissociation CHAPTER 10 Acute Scapholunate and Lunotriquetral Dissociation Craig M. Rodner, MD Arnold-Peter C. Weiss, MD INTRODUCTION: The scapholunate (SL) and lunotriquetral (LT) ligaments are interosseous carpal

More information

The Hand Exam: Tips and Tricks

The Hand Exam: Tips and Tricks The Hand Exam: Tips and Tricks Nikki Strauss Schroeder, MD Assistant Clinical Professor, UCSF Department of Orthopaedic Surgery November 4, 2013 Outline Surface Anatomy Hand Anatomy Exam Management of

More information

Whether a physician is

Whether a physician is ILLUSTRATIONS BY SCOT BODELL Hand and Wrist Injuries: Part I. Nonemergent Evaluation JAMES M. DANIELS II, M.D., M.P.H., Southern Illinois University School of Medicine, Quincy, Illinois ELVIN G. ZOOK,

More information

Scaphoid fractures. Studies on diagnosis and treatment. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 358

Scaphoid fractures. Studies on diagnosis and treatment. Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 358 Digital Comprehensive Summaries of Uppsala Dissertations from the Faculty of Medicine 358 Scaphoid fractures Studies on diagnosis and treatment BERTIL VINNARS ACTA UNIVERSITATIS UPSALIENSIS UPPSALA 2008

More information

Hand and Wrist Injuries and Conditions

Hand and Wrist Injuries and Conditions Hand and Wrist Injuries and Conditions Julia Wild Hand Therapist www.southernhandtherapy.com.au 02 9553 8597 POSI Position of Safe Immobilisation So everything is balanced Wrist 30⁰ ext MCP 70⁰ flex for

More information

Sports Related Injuries of the Hand, Wrist and Elbow. Melissa Nayak, M.D. Department of Orthopaedics Division of Sports Medicine

Sports Related Injuries of the Hand, Wrist and Elbow. Melissa Nayak, M.D. Department of Orthopaedics Division of Sports Medicine Sports Related Injuries of the Hand, Wrist and Elbow Melissa Nayak, M.D. Department of Orthopaedics Division of Sports Medicine Injury triage History, mechanism of injury (MOI) Assess extent of swelling,

More information

Syndesmosis Injuries

Syndesmosis Injuries Syndesmosis Injuries Dr. Alex Rabinovich Outline Anatomy Injury types and classification Treatment options Nonoperative vs. Operative Indications for operative Operative technique Postoperative management

More information

The wrist and hand are constructed of a series of complex, delicately balanced joints whose function is essential to almost every act of daily living.

The wrist and hand are constructed of a series of complex, delicately balanced joints whose function is essential to almost every act of daily living. TOPIC OUTLINE 9- THE WRIST AND HAND. Introduction. The wrist and hand are constructed of a series of complex, delicately balanced joints whose function is essential to almost every act of daily living.

More information

CoNGRUENT RADIAL HEAD PLATE

CoNGRUENT RADIAL HEAD PLATE Mayo Clinic CoNGRUENT RADIAL HEAD PLATE Since 1988 Acumed has been designing solutions to the demanding situations facing orthopedic surgeons, hospitals and their patients. Our strategy has been to know

More information

There are several different causes, both idiopathic

There are several different causes, both idiopathic REVIEW ARTICLE Osteoarthritis of the Wrist Krista E. Weiss, Craig M. Rodner, MD From Harvard College, Cambridge, MA and Department of Orthopaedic Surgery, University of Connecticut Health Center, Farmington,

More information

Scaphoid Fracture in the Elite Athlete

Scaphoid Fracture in the Elite Athlete Scaphoid Fracture in the Elite Athlete Mark R. Belsky, MD*, Matthew I. Leibman, MD, David E. Ruchelsman, MD KEYWORDS Scaphoid Fracture Wrist Athlete KEY POINTS Operative fixation is preferred to casting

More information

11/18/2009. day 1. 6 weeks

11/18/2009. day 1. 6 weeks 11/18/2009 from Fractures of the Distal Radius : a practical approach to management DL Fernandez and JB Jupiter, Springer, New York, 1995 SGH, Biel, 2009 FRACTURES OF THE DISTAL RADIUS: do we still indicate

More information

Name them. Clenched Fist A-P

Name them. Clenched Fist A-P Sports Injuries Not To Misdiagnose LtCol Fred H. Brennan, Jr., DO, FAOASM, FAAFP, FACSM Head Team Physician, University of New Hampshire Deputy Commander, 157 th Medical Group, Pease ANGB To improve the

More information

Common Hand and Wrist Conditions: When to Refer? Dr Tim Heath

Common Hand and Wrist Conditions: When to Refer? Dr Tim Heath Common Hand and Wrist Conditions: When to Refer? Dr Tim Heath Difficult Balance Many hand conditions can be managed non-operatively / simply Missed injury or delayed diagnosis not uncommon Common Problems

More information

We studied 45 patients with 46 fractures of the

We studied 45 patients with 46 fractures of the Patterns of healing of scaphoid fractures THE IMPORTANCE OF VASCULARITY R. W. Kulkarni, R. Wollstein, R. Tayar, N. Citron From the St Helier Hospital, Carshalton, England We studied 45 patients with 46

More information

Radiological diagnosis of injuries following Fall on outstretched hand (FOOSH)

Radiological diagnosis of injuries following Fall on outstretched hand (FOOSH) snap to grid Radiological diagnosis of injuries following Fall on outstretched hand (FOOSH) Core Radiology Clerkship Beth Israel Deaconess Medical Center Ziad Obermeyer, MS4 Gillian Lieberman, MD 18 September

More information

eng Integra surgical technique Spider and Mini-Spider Limited Wrist Fusion System Products for sale in Europe, Middle-East and Africa only.

eng Integra surgical technique Spider and Mini-Spider Limited Wrist Fusion System Products for sale in Europe, Middle-East and Africa only. eng Integra Spider and Mini-Spider Limited Wrist Fusion System surgical technique Table of contents Indications... 03 Contraindications... 03 Features... 03 Component Materials... 03 Surgical Technique

More information

Semmelweis University Department of Traumatology Dr. Gál Tamás

Semmelweis University Department of Traumatology Dr. Gál Tamás Semmelweis University Department of Traumatology Dr. Gál Tamás Anatomy Ankle injuries DIRECT INDIRECT Vertical Compression (Tibia plafond Pilon) AO 43-A,B,C Suppination (adduction + inversion) AO 44-A

More information

THE WRIST. At a glance. 1. Introduction

THE WRIST. At a glance. 1. Introduction THE WRIST At a glance The wrist is possibly the most important of all joints in everyday and professional life. It is under strain not only in many blue collar trades, but also in sports and is therefore

More information

Scaphoid Fractures Epidemiology, diagnosis and treatment

Scaphoid Fractures Epidemiology, diagnosis and treatment PETER JØRGSHOLM Print by Media-Tryck Lund University 2015 Scaphoid Fractures Epidemiology, diagnosis and treatment Scaphoid Fractures The scaphoid is the most commonly fractured carpal bone. The diagnosis

More information

Various classifications of scaphoid fractures have

Various classifications of scaphoid fractures have The anatomy of acute scaphoid fractures A THREE-DIMENSIONAL ANALYSIS OF PATTERNS J. P. Compson From the United Medical and Dental Schools of Guy s and St Thomas Hospitals, London, England Various classifications

More information

Common Injuries of the Hand, Wrist, & Elbow. Terry M. Messer, MD October 25, 2007

Common Injuries of the Hand, Wrist, & Elbow. Terry M. Messer, MD October 25, 2007 Common Injuries of the Hand, Wrist, & Elbow Terry M. Messer, MD October 25, 2007 Introduction! Hand, Wrist, & Elbow Injuries are common! Increase in intensity/frequency of sports training! Sedentary lifestyle

More information

Radius and Scaphoid Fractures

Radius and Scaphoid Fractures Page 1 of 7 Return to the Table of Contents Site Map Your Account Support About Us Marketplace Offerings: Medscape.com Charts Mobile Logician CBSHealthwatch American Academy of Orthopaedic Surgeons Annual

More information

ASSOCIATE PROFESSOR BO POVLSEN Emeritus Consultant Orthopaedic Surgeon Guy s & St Thomas Hospitals NHS Trust GMC no. 3579329

ASSOCIATE PROFESSOR BO POVLSEN Emeritus Consultant Orthopaedic Surgeon Guy s & St Thomas Hospitals NHS Trust GMC no. 3579329 ASSOCIATE PROFESSOR BO POVLSEN Emeritus Consultant Orthopaedic Surgeon Guy s & St Thomas Hospitals NHS Trust GMC no. 3579329 Consultant Orthopaedic Surgeon London Bridge Hospital Medico-Legal Secretary:

More information

ACUTE HAND INJURY PROTOCOLS

ACUTE HAND INJURY PROTOCOLS ACUTE HAND INJURY PROTOCOLS I. FRACTURES OF THE HAND AND DIGITS Digital and hand fractures are seen in workers who use their hands, due to the exposed nature of the hand (in most functions) at work. Most

More information

Malleolar fractures Anna Ekman, Lena Brauer

Malleolar fractures Anna Ekman, Lena Brauer Malleolar fractures Anna Ekman, Lena Brauer How to use this handout? The left column is the information as given during the lecture. The column at the right gives you space to make personal notes. Learning

More information

Forearm Fractures 09/18/2013. Mechanism: Usually a fall on an outstretched arm. Incidence. Mechansim

Forearm Fractures 09/18/2013. Mechanism: Usually a fall on an outstretched arm. Incidence. Mechansim September 20, 2013 Amanda Taylor PA-C Children s Orthopaedics of Louisville Forearm Fractures Incidence 40-50% of all pediatric fractures Mechansim Wide range of mechanism Mechanism: Usually a fall on

More information

9 DISTAL RADIUS AND ULNA FRACTURES

9 DISTAL RADIUS AND ULNA FRACTURES 9: DISTAL RADIUS AND ULNA FRACTURES Rockwood and Wilkins Fractures in Children 9 DISTAL RADIUS AND ULNA FRACTURES PETER M. WATERS Classification Anatomy Physeal Injuries Diagnosis Treatment Options Complications

More information

Pediatric Sports Injuries of the Wrist and Hand. Sunni Alford, OTR/L,CHT Preferred Physical Therapy

Pediatric Sports Injuries of the Wrist and Hand. Sunni Alford, OTR/L,CHT Preferred Physical Therapy Pediatric Sports Injuries of the Wrist and Hand Sunni Alford, OTR/L,CHT Preferred Physical Therapy Wrist injuries TFCC ECU/ FCU tendonitis Instability Growth Plate Fractures Ulnar abutment syndrome Triangular

More information

ISOLATED FRACTURE OF THE CAPITATE : THE VALUE OF MRI IN DIAGNOSIS AND FOLLOW UP

ISOLATED FRACTURE OF THE CAPITATE : THE VALUE OF MRI IN DIAGNOSIS AND FOLLOW UP CASE REPORT ISOLATED FRACTURE OF THE CAPITATE : THE VALUE OF MRI IN DIAGNOSIS AND FOLLOW UP F. DE SCHRIJVER 1, L. DE SMET 1 We report 2 new cases of isolated fracture of the capitate. The diagnosis and

More information

TwinFix Cannulated Compression Screw

TwinFix Cannulated Compression Screw TwinFix Cannulated Compression Screw Leibinger Solutions for Hand Surgery Procedural Guide TwinFix Sterilization, Organization, Storage 29-12020 Profyle MODULAR Sterilizing Container 29-40162 TwinFix Implant

More information

Elbow, Forearm, Wrist, & Hand. Bony Anatomy. Objectives. Bones. Bones. Bones

Elbow, Forearm, Wrist, & Hand. Bony Anatomy. Objectives. Bones. Bones. Bones Objectives Elbow, Forearm, Wrist, & Hand Chapter 19 Identify and discuss the functional anatomy of the elbow and forearm Discuss the common injuries associated with these anatomical structures Bones Humerus

More information

I have been provided with information to answer your request by Ms Lyn McDonald, Site Director, Royal Infirmary of Edinburgh.

I have been provided with information to answer your request by Ms Lyn McDonald, Site Director, Royal Infirmary of Edinburgh. Lothian NHS Board = Waverley Gate 2-4 Waterloo Place Edinburgh EH1 3EG = Telephone: 0131 536 9000 www.nhslothian.scot.nhs.uk Date: 15/06/2015 Our Ref: 5229 Enquiries to : Bryony Pillath Extension: 35676

More information

ASSOCIATED LESIONS COMPLICATIONS OSTEOARTICULAR COMPLICATIONS

ASSOCIATED LESIONS COMPLICATIONS OSTEOARTICULAR COMPLICATIONS Corrective Osteotomy of Distal Radius Malunion---New Horizons I certify that, to the best of my knowledge, no aspect of my current personal or profession situation might reasonably be expected to affect

More information

Management of common upper limb fractures in Adults and Children. Dr Matthew Sherlock Shoulder and Elbow Orthopaedic Surgeon

Management of common upper limb fractures in Adults and Children. Dr Matthew Sherlock Shoulder and Elbow Orthopaedic Surgeon Management of common upper limb fractures in Adults and Children Dr Matthew Sherlock Shoulder and Elbow Orthopaedic Surgeon Outline Immobilisation choices Adults Clavicle Fractures Proximal Humeral Fractures

More information

Minimal Invasive Treatment for Scaphoid Fractures Using the Cannulated Herbert Screw System

Minimal Invasive Treatment for Scaphoid Fractures Using the Cannulated Herbert Screw System Techniques in Hand and Upper Extremity Surgery 7(4):141 146, 2003 T E C H N I Q U E 2003 Lippincott Williams & Wilkins, Inc., Philadelphia Minimal Invasive Treatment for Scaphoid Fractures Using the Cannulated

More information

Non Operative Management of Common Fractures

Non Operative Management of Common Fractures Non Operative Management of Common Fractures Mr Duy Thai Orthopaedic Surgeon MBBS, FRACS (Ortho), Dip Surg Anat NOT ALL FRACTURES NEED TO BE FIXED FRACTURE CLINIC EMERGENCY DEPARTMENTS GENERAL PRACTITIONERS

More information

Examination of the Elbow. Elbow Examination. Structures to Examine. Active Range of Motion. Active Range of Motion 8/22/2012

Examination of the Elbow. Elbow Examination. Structures to Examine. Active Range of Motion. Active Range of Motion 8/22/2012 Examination of the Elbow The elbow is a complex modified hinge joint The humero-ulnar joint is a hinge joint allowing flexion and extension The radio-ulnar joint allows for pronation and supination of

More information

Treatment Guide Understanding Hand and Wrist Pain. Using this Guide. Choosing Your Care

Treatment Guide Understanding Hand and Wrist Pain. Using this Guide. Choosing Your Care Treatment Guide Understanding Hand and Wrist Pain With how much we rely on our hands, there s no wonder hand and wrist pain can be so disabling and frustrating. When this pain interferes with typing on

More information

A Systematic Approach To A Painful Wrist

A Systematic Approach To A Painful Wrist A Systematic Approach To A Painful Wrist Although wrist injuries are not life threatening, they are of great importance in terms of how they can affect daily functioning. Without an accurate diagnosis,

More information

Adult Forearm Fractures

Adult Forearm Fractures Adult Forearm Fractures Your forearm is made up of two bones, the radius and ulna. In most cases of adult forearm fractures, both bones are broken. Fractures of the forearm can occur near the wrist at

More information

Motion-preserving salvage surgery of the wrist after a scaphoid non-union or scapholunate dissociation

Motion-preserving salvage surgery of the wrist after a scaphoid non-union or scapholunate dissociation Volume 01 / Issue 02 / September 2013 boa.ac.uk Page 50 Motion-preserving salvage surgery of the wrist after a scaphoid non-union or scapholunate dissociation Joseph J Dias This article looks at salvage

More information

Common Pediatric Fractures. Quoc-Phong Tran, MD UNSOM Primary Care Sports Medicine Fellow November 6, 2014

Common Pediatric Fractures. Quoc-Phong Tran, MD UNSOM Primary Care Sports Medicine Fellow November 6, 2014 Common Pediatric Fractures Quoc-Phong Tran, MD UNSOM Primary Care Sports Medicine Fellow November 6, 2014 Pediatric fractures 20% of injured kids found to have fracture on evaluation Between birth and

More information

Sports Injuries of the Foot and Ankle. Dr. Travis Kieckbusch August 7, 2014

Sports Injuries of the Foot and Ankle. Dr. Travis Kieckbusch August 7, 2014 Sports Injuries of the Foot and Ankle Dr. Travis Kieckbusch August 7, 2014 Foot and Ankle Injuries in Athletes Lateral ankle sprains Syndesmosis sprains high ankle sprain Achilles tendon injuries Lisfranc

More information

HAND & WRIST REHAB AFTER SPORTS INJURY Jennifer Allen,PT,OCS,CHT. Overview. Why do ATCs Need to Know Hand Injury Info?

HAND & WRIST REHAB AFTER SPORTS INJURY Jennifer Allen,PT,OCS,CHT. Overview. Why do ATCs Need to Know Hand Injury Info? HAND & WRIST REHAB AFTER SPORTS INJURY Jennifer Allen,PT,OCS,CHT Overview Why do ATCs Need to Know Hand Injury Info? 1 Incidence of Hand Injury in Sports NFL Combine Review 1987-2000 Ankle Sprain 29.1%

More information

Injury to the Scapholunate Ligament in Sport A Case Report

Injury to the Scapholunate Ligament in Sport A Case Report World Journal of Sport Sciences 7 (3): 154-159, 2012 ISSN 2078-4724 IDOSI Publications, 2012 DOI: 10.5829/idosi.wjss.2012.7.3.71228 Injury to the Scapholunate Ligament in Sport A Case Report 1 1 1 SoutAkbar

More information

ASOP Exams PO Box 7440 Seminole, FL 33775. The Manual of Fracture Casting & Bracing Exam 80% Passing ID # Name Title. Address. City State Zip.

ASOP Exams PO Box 7440 Seminole, FL 33775. The Manual of Fracture Casting & Bracing Exam 80% Passing ID # Name Title. Address. City State Zip. The Manual of Fracture Casting & Bracing Exam 80% Passing ID # Name Title Address City State Zip Tel# Email Certification Organization Cert# Mail a copy of your completed exam to: ASOP Exams PO Box 7440

More information

Arthroscopy of the Hand and Wrist

Arthroscopy of the Hand and Wrist Arthroscopy of the Hand and Wrist Arthroscopy is a minimally invasive procedure whereby a small camera is inserted through small incisions of a few millimeters each around a joint to view the joint directly.

More information

TENDON INJURIES OF THE HAND KEY FIGURES:

TENDON INJURIES OF THE HAND KEY FIGURES: Chapter 32 TENDON INJURIES OF THE HAND KEY FIGURES: Extensor surface of hand Mallet finger Mallet splints Injured finger in stack splint Repair of open mallet Most hand specialists believe that the earlier

More information

The Dilemmas of a Scaphoid Fracture: A Difficult Diagnosis for Primary Care Physicians

The Dilemmas of a Scaphoid Fracture: A Difficult Diagnosis for Primary Care Physicians Clinical Review Article The Dilemmas of a Scaphoid Fracture: A Difficult Diagnosis for Primary Care Physicians Ryan Nishihara, MD Scaphoid fractures account for 2% to 7% of all orthopedic fractures, 1

More information

Hand Mobility Deficits. 883.2 Open wound of finger with tendon involvement

Hand Mobility Deficits. 883.2 Open wound of finger with tendon involvement 1 Hand Mobility Deficits ICD-9-CM codes: 882.2 Open wound of hand with tendon involvement 883.2 Open wound of finger with tendon involvement ICF codes: Activities and Participation code: d4301 Carrying

More information

UPPER EXTREMITY INJURIES IN SPORTS

UPPER EXTREMITY INJURIES IN SPORTS UPPER EXTREMITY INJURIES IN SPORTS Wrist and Hand Injuries in the Athlete Tim L. Uhl, PhD, ATC, PT Philip Blazar, MD Greg Pitts, MS, OTR/L, CHT Kelly Ramsdell, ATC CHAPTER 2 Sports Physical Therapy Section

More information

We compared the long-term outcome in 61

We compared the long-term outcome in 61 Fracture of the carpal scaphoid A PROSPECTIVE, RANDOMISED 12-YEAR FOLLOW-UP COMPARING OPERATIVE AND CONSERVATIVE TREATMENT B. Saedén, H. Törnkvist, S. Ponzer, M. Höglund From Stockholm Söder Hospital,

More information

3. Be able to perform a detailed clinical examination of the forearm and wrist.

3. Be able to perform a detailed clinical examination of the forearm and wrist. Patient Care: 1. Demonstrate appropriate evaluation and treatment of patients with hand/wrist surgery problems in the emergency room and as part of the inpatient consultation service, including application

More information

ANTERIOR CERVICAL DISCECTOMY AND FUSION. Basic Anatomical Landmarks: Anterior Cervical Spine

ANTERIOR CERVICAL DISCECTOMY AND FUSION. Basic Anatomical Landmarks: Anterior Cervical Spine Anterior In the human anatomy, referring to the front surface of the body or position of one structure relative to another Cervical Relating to the neck, in the spine relating to the first seven vertebrae

More information

The Elbow, Forearm, Wrist, and Hand

The Elbow, Forearm, Wrist, and Hand Elbow - Bones The Elbow, Forearm, Wrist, and Hand Chapters 23 & 24 Humerus Distal end forms the medial & lateral condyles Lateral: capitulum Medial: trochlea Radius Ulna Sports Medicine II Elbow - Bones

More information

Vivian Gonzalez Gillian Lieberman, MD. January 2002. Lumbar Spine Trauma. Vivian Gonzalez, Harvard Medical School Year III Gillian Lieberman, MD

Vivian Gonzalez Gillian Lieberman, MD. January 2002. Lumbar Spine Trauma. Vivian Gonzalez, Harvard Medical School Year III Gillian Lieberman, MD January 2002 Lumbar Spine Trauma Vivian Gonzalez, Harvard Medical School Year III Agenda Anatomy and Biomechanics of Lumbar Spine Three-Column Concept Classification of Fractures Our Patient Imaging Modalities

More information

Upper Limb QUESTIONS UPPER LIMB: QUESTIONS

Upper Limb QUESTIONS UPPER LIMB: QUESTIONS 1 Upper Limb QUESTIONS 1.1 Which of the following statements best describes the scapula? a. It usually overlies the 2nd to 9th ribs. b. The spine continues laterally as the coracoid process. c. The suprascapular

More information

.org. Ankle Fractures (Broken Ankle) Anatomy

.org. Ankle Fractures (Broken Ankle) Anatomy Ankle Fractures (Broken Ankle) Page ( 1 ) A broken ankle is also known as an ankle fracture. This means that one or more of the bones that make up the ankle joint are broken. A fractured ankle can range

More information

Examination and treatment of scaphoid fractures and pseudarthrosis 1138 42

Examination and treatment of scaphoid fractures and pseudarthrosis 1138 42 Review article Examination and treatment of scaphoid fractures and pseudarthrosis 1138 42 BACKGROUND About 2 000 patients annually incur a fractured scaphoid in Norway. Assessment and diagnosis can be

More information

ESSENTIALPRINCIPLES. Wrist Pain. Radial and Ulnar Collateral Ligament Injuries. By Ben Benjamin

ESSENTIALPRINCIPLES. Wrist Pain. Radial and Ulnar Collateral Ligament Injuries. By Ben Benjamin ESSENTIALPRINCIPLES Wrist Pain Radial and Ulnar Collateral Ligament Injuries By Ben Benjamin 92 MASSAGE & BODYWORK FEBRUARY/MARCH 2005 Ulnar Collateral Ligament Radial Collateral Ligament Right wrist,

More information